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The promises and problems of transpulmonary pressure measurements in acute respiratory distress syndrome

Sahetya, Sarina K.; Brower, Roy G.

Current Opinion in Critical Care: February 2016 - Volume 22 - Issue 1 - p 7–13
doi: 10.1097/MCC.0000000000000268
RESPIRATORY SYSTEM: Edited by Marco Ranieri

Purpose of review The optimal strategy for assessing and preventing ventilator-induced lung injury in the acute respiratory distress syndrome (ARDS) is controversial. Recent investigative efforts have focused on personalizing ventilator settings to individual respiratory mechanics. This review examines the strengths and weaknesses of using transpulmonary pressure measurements to guide ventilator management in ARDS.

Recent findings Recent clinical studies suggest that adjusting ventilator settings based on transpulmonary pressure measurements is feasible, may improve oxygenation, and reduce ventilator-induced lung injury.

Summary The measurement of transpulmonary pressure relies upon esophageal manometry, which requires the acceptance of several assumptions and potential errors. Notably, this includes the ability of localized esophageal pressures to represent global pleural pressure. Recent investigations demonstrated improved oxygenation in ARDS patients when positive end-expiratory pressure was adjusted to target specific end-inspiratory or end-expiratory transpulmonary pressures. However, there are different methods for estimating transpulmonary pressure and different goals for positive end-expiratory pressure titration among recent studies. More research is needed to refine techniques for the estimation and utilization of transpulmonary pressure to guide ventilator settings in ARDS patients.

Department of Medicine, Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA

Correspondence to Roy G. Brower, MD, Department of Medicine, Pulmonary and Critical Care Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower Suite 9121, Baltimore, MD 21287, USA. Tel: +1 410 614 6292; e-mail: rbrower@jhmi.edu

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